Provider Demographics
NPI:1639120462
Name:RANALLI, JEFFERY (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:
Last Name:RANALLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDFORD LEAS
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2254
Mailing Address - Country:US
Mailing Address - Phone:609-654-3427
Mailing Address - Fax:856-783-0649
Practice Address - Street 1:1 MEDFORD LEAS
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2254
Practice Address - Country:US
Practice Address - Phone:609-654-3427
Practice Address - Fax:856-783-0649
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06402900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7800100Medicaid
NJ7800100Medicaid